Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,733.00 / $5,132.00 / $22,024.00	Facility		$1,733.00	$5,132.00	$22,024.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,184.96 / $1,624.37 / $3,478.54	Professional		$1,184.96	$1,624.37	$3,478.54
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,749.40 / $15,599.20 / $31,745.76	Facility		$1,749.40	$15,599.20	$31,745.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,800.69 / $2,907.18 / $11,095.13	Professional		$1,800.69	$2,907.18	$11,095.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $765.00 / $870.49 / $870.49	Facility		$765.00	$870.49	$870.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,274.66 / $2,291.82 / $3,872.61	Professional		$1,274.66	$2,291.82	$3,872.61
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,215.51 / $2,503.19 / $3,902.81	Facility		$1,215.51	$2,503.19	$3,902.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,215.51 / $2,424.88 / $3,244.62	Professional		$1,215.51	$2,424.88	$3,244.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $155.55 / $713.64 / $2,507.40	Professional		$155.55	$713.64	$2,507.40
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,680.30 / $2,291.40 / $2,564.76	Facility		$1,680.30	$2,291.40	$2,564.76
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,711.43 / $1,711.43 / $1,749.40	Facility		$1,711.43	$1,711.43	$1,749.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,961.17 / $2,795.72 / $3,472.38	Professional		$1,961.17	$2,795.72	$3,472.38
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $12,109.64 / $16,586.25 / $31,745.76	Facility		$12,109.64	$16,586.25	$31,745.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,745.44 / $2,490.04 / $3,315.05	Professional		$1,745.44	$2,490.04	$3,315.05
United Facility/Professional Facility Modifier Low / Median / High Price $2,912.00 / $4,016.00 / $16,315.00	Facility		$2,912.00	$4,016.00	$16,315.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,529.10 / $2,099.34 / $3,665.97	Professional		$1,529.10	$2,099.34	$3,665.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,065.90 / $1,065.90 / $1,376.68	Professional		$1,065.90	$1,065.90	$1,376.68